CARE HOME ADULTS 18-65
Mayfield House 41 London Road Liphook Hampshire GU30 7AP Lead Inspector
Laurie Stride Unannounced Inspection 16th October 2006 10:30 Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mayfield House Address 41 London Road Liphook Hampshire GU30 7AP 01428 724982 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Gayawotee Rayola Jingree Mrs Gayawotee Rayola Jingree Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (2) of places Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users in the LD category referred to above are only to be admitted between 35 and 65 years 10th October 2005 Date of last inspection Brief Description of the Service: Mayfield House is a care home providing personal care and accommodation for up to 12 service users in the category of learning disability and is owned by Mr and Mrs Jingree who is also the registered manager. The home is situated within close proximity of the town of Liphook that has a range of leisure and recreational facilities. Mayfield House has a communal lounge and communal dinning room and a garden to the rear with seating. The current range of fees is £64.34 - £134.58 per day. Items not covered by fee include hairdressing, chiropody, toiletries, transport and holidays. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection visit was carried out on 16/10/06 and lasted seven hours. During this time the inspector had the opportunity to observe some of the residents at home and staff members at work, speak with three residents, three staff members and the registered manager. A tour of the premises was undertaken and samples of documents held in the home were seen. A pre-inspection questionnaire, completed by the registered manager, provided additional information about the home used in this report. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 7 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for assessing the individual needs of prospective residents enable them and the home to make a decision about whether the home can meet their needs. EVIDENCE: The registered manager confirmed that there have been no new admissions to the home in the last 12 months and no change to the admissions procedure. There has been one discharge in that time. The previous report on the home identified that arrangements for assessing the needs of prospective residents were good. The home conducts a formal assessment and obtains a care manager’s assessment where this is applicable. Prospective residents are able to visit the home prior to admission, for a meal and to spend time with the other residents. In the sample of three care plans seen during this inspection visit the original records of assessments for those residents were on file. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in making decisions about their lives and take part in planning the care and support they receive. However, care plans should be further improved through greater detail about how the home meets all of residents’ leisure and social needs. EVIDENCE: A sample of three residents’ care plans was seen and contained detailed information about individual care needs. The plans were in a format that identified a need or goal, then an action plan to meet the need, followed by a record of the outcome and when the plan was reviewed. Two of the residents spoken with confirmed knowledge of their care plans and that they attended their reviews along with their care managers. Care plans had been further developed to include more detail about residents’ community access and activities. The plans showed individual social interests and preferences, but were not clear about the method by which these areas of need were to be addressed and the outcomes of any strategies employed in this respect. The registered manager agreed that this was an area that needed
Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 9 further development (see also section on Lifestyle). Two residents spoken with indicated that they were involved in activities that suited them, both inside and outside the home. Daily records completed by staff showed what activities residents took part in and their interactions with others. Two members of staff talked about how they promote residents’ activities and choice and two residents confirmed through discussion that choice is offered them. It was observed that staff provided residents with information to assist them in making decisions and residents participated in the daily routines of the home. Records provided further evidence that the home consulted residents about their satisfaction with their care and social activities (see also section on Conduct and Management of the Home). Risk assessments in relation to individual residents’ needs, behaviour and activities were recorded in care plans. These showed that residents were supported to maintain their independence, for example in going out alone or in managing their own money and medication. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about their lifestyle and are supported to develop their life skills. Better documentation is needed to show how the home meets all residents’ social and recreational needs and wishes. EVIDENCE: Care plans and daily records provided evidence that resident’s individual hobbies and interests are supported in the home, for example, puzzles, arts and crafts, board games and music. Individual living skills are promoted in the home, for example one resident cooks the tea on Fridays. Some residents also have a regular timetable of educational and leisure activities that they access through their day service. It was confirmed through discussion with residents and staff that the home arranges outings to places of interest and for meals. There is a monthly charge for transport, which all residents pay and was originally agreed with residents’ care management team, as evidenced by the home’s records. The home was not able to clearly show how each of the current residents benefit equally from this arrangement and it was agreed that this would be reviewed.
Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 11 Residents’ goals and aspirations were being incorporated in care plans as they are reviewed, following a previous recommendation. Some residents are able to access the local pubs and shops independently but others cannot and there was not clear evidence to show that they are regularly having the opportunity to go out as part of a structured plan. As mentioned in the previous section, individual care plans need to show how the home meets all of residents’ occupational, leisure and social needs. Important relationships are recorded in individual care plans and residents are supported to maintain contact with families and friends. This was confirmed through discussion with residents and the registered manager. The home encourages residents’ relatives to attend care review meetings, with the residents’ agreement. Staff members spoken to were able to give examples of how residents’ rights and responsibilities are upheld in the home. Residents are involved in the domestic routines of the home, taking responsibility for their own rooms, menu planning and cooking meals, with staff support if needed. This was confirmed through discussion with residents, observation and care plan records. The atmosphere of the home is relaxed and encourages residents to speak their mind and express their wishes. Healthy diets are promoted and written into individual care plans as necessary. One resident has diet-controlled diabetes, which was detailed in their care plan, and other resident’s needs such as low cholesterol and low-sodium diets were also documented and catered for. The home offers a four-week menu, which appeared to offer variety and fresh wholesome food. The menu states an alternative to each meal. Residents said the food was good and confirmed they are involved in drawing up the menu and are asked before each meal what they would prefer. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive health and personal care based on their individual needs, and detailed care plans and consultation promote dignity and choice. The further measures taken to limit a new property overlooking resident’s bedrooms will improve their privacy. EVIDENCE: The previous report showed that discussion had taken place with residents about how to improve their privacy at the back of the house, which is overlooked by a private dwelling. Blinds had been fitted to bedrooms at the back of the house and since the last inspection, following further consultation, trees have been planted which will improve resident’s privacy. Residents’ care plans contained information about their needs and preferences with regard to personal support, including guidance for staff about residents’ psychological wellbeing, emotional support and behaviour management plans. The home operates a key worker system and one resident said that staff support them well and ask them if everything is ok. The home’s records provided further evidence that residents are consulted about their satisfaction with the care and support they receive. Records showed that the home was
Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 13 liaising with the care management team about additional support for one resident following a review of their needs. Records of health appointments and outcomes are kept in residents’ care plans, including details of any medication changes prescribed by the doctor or consultant. Hearing tests had been arranged for one resident in accordance with their reviewed care plan. A resident said that they saw their doctor when they needed to. A healthcare professional was seen visiting a resident in the home. The home has a written policy and procedure for the control, administration, recording, safekeeping, handling and disposal of medicines. Medication is stored securely in the office. The home uses a monitored dosage system and medication administration records. With the exception of a staff signature indicating that medication had been given when it had not and was not due to be given, the sample of medication records seen were completed correctly, and the manager said she would look into the error. Some residents are supported to manage their own medication, based on a risk assessment. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems for ensuring that residents’ views are listened to and responding to any complaints. Residents are protected by the home’s policies and procedures for responding to any form or allegation of abuse. EVIDENCE: There is a comprehensive written complaints policy and procedure, which is also included in the home’s Service User Guide. The registered manager reported that the home had received one complaint that was found to be unsubstantiated. A complaints record book was in place, which held details of any concerns received by the home and the outcome of actions taken. Residents meetings are held in the home and there is a complaints box in the living room. Two residents said they knew who to speak to if they had any concerns and residents’ appeared relaxed and comfortable in the home and with staff. There had been one adult protection referral made since the last inspection and this had been dealt with according to the local authority procedures and found to be unsubstantiated. Actions had been agreed between the home and external agencies regarding further support for a resident. The home had subsequently reviewed the resident’s care plan and risk assessment and were liaising with the care management team. Staff members are asked to read and sign the adult protection policy and two members of staff spoken to demonstrated clear understanding of the procedures.
Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 15 Residents are supported to manage their own money if they are able and wish to do so. The home looks after some residents’ money and a record of transactions was seen. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a safe, clean and comfortable environment. EVIDENCE: The inspector was shown round the premises, which were clean, bright and homely. Since the last inspection a new shower had been installed, two windows had been replaced, new flooring had been put down in the laundry area and the home had purchased a new fridge and cooker. There is a continuing redecoration programme to ensure a good standard is maintained. Repairs had been carried out following a water leak, which had left marks on a residents’ bedroom wall and the registered manager confirmed that the room was also going to be redecorated. Residents said they liked their home and their bedrooms. The registered manager reported that the fire officer had inspected the premises on 14/06/06 and was satisfied with the fire safety systems in place. The laundry room is separate from areas where food is stored, prepared or eaten and was suitably equipped, including a hand washing facility. Staff are trained in infection control and gloves and aprons were available.
Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 17 Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff in the home are clear about their role and are encouraged and supported to undertake care related qualifications. Training is provided although the induction programme should be clearly in line with the national standard and regular supervision must be maintained. The home’s recruitment practices are not clear and robust and this puts residents at risk. EVIDENCE: Seven care workers are currently employed in the home. Two were starting National Vocational Qualification (NVQ) level 2 and two had completed level 3. A further three had applied to do level 3. The manager is currently undertaking NVQ level 4 in management. The staff training record indicated that since the last inspection staff had received training in person centred planning; equality, diversity and rights; food hygiene; medication awareness; fire safety awareness; abuse and adult protection, and ongoing NVQ. The registered manager had given staff in-house training on the history of learning disability. The registered manager reported that further training sessions in first aid, food hygiene and infection control were taking place in October and November. Staff members spoken to were clear about their roles and said they are happy with the training and support they get. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 19 New staff members are given the home’s induction programme and this includes an introduction to residents and basic care skills. It was advised that the registered manager check that the programme is in line with the Skills For Care Common Induction Standards. A previous requirement had been made that a Criminal Records Bureau (CRB) check must be carried out on all staff before they start their employment. The home has a policy and procedure for the recruitment of new staff and a sample of two staff member’s records was seen. Both members of staff had commenced employment before CRB checks had been obtained, but there were no records of the home having obtained Protection of Vulnerable Adults (POVA) checks first, although copies of overseas police checks were on file. The registered manager said one POVA check had been obtained over the telephone. Two written references for each person were on file but did not give clear and satisfactory information, although these did confirm the previous employment and professional status of the individuals. The staff rota for the period indicated that the members of staff had not been under supervision at work and the registered manager confirmed this. Risk assessments had not been recorded showing how the decision to employ under the circumstances had been reached. One of the staff members had lived for a short period of time at Mayfield House prior to their employment and had access to the residents’ kitchen. A requirement has been made regarding the need for robust recruitment processes to be demonstrated in order to protect residents. Supervision records were on file and were up-to-date for some staff, but others did not appear to have had formal supervision since April. The registered manager had one current supervision record in note form and two others were seen for September. The registered manager said that she had started appraisals with staff and a completed self-appraisal form was seen in relation to one staff member. The rota showed that the registered manager is usually in the home between the hours of 8am and 4pm, Monday to Friday, to supervise staff informally. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well run and the registered manager is working to improve the service, including existing quality assurance systems, which seek the views of residents. The homes policies and procedures mainly promote the health, safety and welfare of residents, but clear procedures for the recruitment and supervision of staff are not followed. EVIDENCE: The registered manager is currently undertaking NVQ level 4. She works hands on in the home as well as cascading training to staff. Staff spoken to confirmed that the home is well run and that they feel well supported. As identified in the previous section, the management of the home must include ensuring robust recruitment procedures are always applied and that all staff members are formally supervised at least six times a year. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 21 A residents survey had been undertaken, including their views about room sharing, food, choices, activities, care and support and any changes or improvements that might be made. A report or record of the outcomes of any action taken in relation to the survey was not yet available. The registered manager said she also planned to widen the scope of the survey to include other stakeholders such as relatives, staff and external agencies. There are fortnightly resident’s meetings and regular staff meetings. Residents’ views and those of their families and representatives and staff are also sought during annual review meetings, staff appraisals and the annual maintenance appraisal. Residents spoken to confirmed they felt involved in the running of the home. The home had a manual of relevant policies and procedures and these were being systematically reviewed. A checklist was in place to ensure that staff read and understood them. Staff members have training in moving and handling and fire safety. The records of fire safety training and drills, checks on equipment, alarm systems and fire doors were seen and were up to date. A fire safety risk assessment and maintenance checklist for the home was in place. Fire safety equipment is situated around the home and fire safety instructions for residents are held on their files and reviewed regularly. Two residents spoken to knew what to do in the event that a fire alarm should go off. Records were also seen of regular checks and servicing carried out on domestic equipment and appliances, including the stair lift. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 17 Requirement Where new staff members are employed at the home, prior to a full CRB check being obtained, they start work on a supervised basis only after satisfactory POVA First and all other relevant checks are confirmed. This requirement is partially repeated from 12/11/05 The registered person must ensure that all staff members are formally supervised at least six times a year. Timescale for action 16/11/06 2. YA36 18(2) 18/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA13 YA35 Good Practice Recommendations It is recommended that care plans be further developed to show how the home meets all of residents’ leisure and social needs. It is recommended that the registered person ensure that the staff induction programme is in line with the Skills For
DS0000011905.V314892.R01.S.doc Version 5.2 Page 24 Mayfield House Care Common Induction Standards. Mayfield House DS0000011905.V314892.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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